Hypertensive Emergency
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Introduction
Hypertensive emergency or crisis is an acute elevation of systolic and diastolic blood pressure with damage to organs such as the eyes, heart, kidneys, or brain.
Hypertensive urgency is acute elevation in the absence of end-organ damage.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Hypertension can be severely increased in a number of conditions, including
- pregnancy-induced hypertension
- renal failure (also an effect of hypertension)
- cessation of beta-blockers
- sympathometic drugs - cocaine, amphetemines, PCP
- MAOI + sympathomemetics or tyramine-containing foods
- phaeochromocytoma
Pathophysiology
Signs and Symptoms
- history
- physical exam
History
Symptoms relate to end-organ damage
CNS: headache, nausea, vomiting, mental status changes
eyes: vision changes
severe ripping chest pain
Physical Exam
Signs include:
- changes on fundoscopy: hemorrhage, exudate, cotton wool spots, papilledema, sausage linking
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
blood
- BUN
- creatinine
urine
- proteinuria
- RBC and RBC casts
Diagnostic Imaging
Differential Diagnosis
Treatments
Commonly used treatments include:
A hypertensive emergency requires IV medications and admission. Important medications include:
- vasodilators (nitroprusside, nitroglycerin, calcium channel blockers, ACE inhibitors)
- sympathetic blockers (beta blockers, phentolamine)
Consequences and Course
Hypertensive encephalpathy
stroke
acute aortic dissection
Left ventricular failure can follow increased peripheral resistance and afterload, leading to angina, infarction, and pulmonary congestion.
Thoracic aortic dissection may also occur.
Encephalopathy can occur with cerebral hyperperfusion, leading to CNS symptoms, retinopathy, coma, and death.
The kidneys are also often damaged by hypertension, leading to failure.
The Case of...
Case #2 - a small story wrapping it all up and asking especially about management.
Additional Resources
Topic Development
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